Version 1.2 Revised 7/20/2025

Quality Measures Included in the Quality Incentive Calculations

The following quality measures are included in Indiana’s Quality Incentive Payment calculations:

  • Hospitalizations per 1,000 resident days (L)

  • ED visits per 1,000 resident days (L)

  • Falls with Major Injury (L)

  • Pressure Ulcers (L)

  • Total Nursing Staff Ratio

How is the Quality Incentive Payment Calculated?

Indiana’s Quality Incentive Payment for MDS QMs is calculated using real time QM Scores calculated by DatAlign for chs.care for the four-quarter rolling period ending with the current quarter to simulate how current performance would impact reimbursement. Claims-based measures data is sourced from the latest available CMS file, with the numerator extrapolated from our calculation of the denominator. 

For the Nursing Staff Ratio QM, QIP is calculated for the current quarter using the adjusted staffing data from the latest available CMS file and is derived from the following formula:

Reported Total Staffing Hours per Resident per DayCasemix Total Staffing Hours per Resident per Day

Points Assignment

Indiana’s QIP points are determined by calculating the cut points for the 40th and 90th percentiles for each QM based on the available QM data for CHS facilities. 

  • Facilities that score equal to or above the national 90th percentile get the maximum number of points. 

  • Facilities that score below the 40th national percentile get 0 points.

  • Facilities with a score between the 40th and 90th percentiles are awarded points using the following formula: 

Minimum Performance Percentile Value - Facility Performance ValueMinimum Performance Percentile Value - Maximum Performance Percentile Value× Total Available Points



Total available points:

  • MDS QMs: 100 points

  • Staffing QM: 125 points

  • Claims-based QMs: 150 points

From Points to Dollars and Cents

The Quality Incentive Payment is calculated using the following formula:

Per diem payment rate × Points × Number of Medicaid days in the period

  • Per diem payment rate: $0.06

  • Number of Medicaid days in the period: The sum of the days of care in the period for patients whose primary payer is Medicaid.

References

Nursing Facility Total Quality Score Summary & Support 

Version 1.2 Revised 7/20/2025